Background The rate of mastectomy is much higher in Newfoundland and Labrador than in any other province in Canada, even for women diagnosed at an early stage. In this paper, we present qualitative data from women who have made a decision for surgical treatment and from breast surgeons in an effort to better explicate factors influencing breast cancer (bca) surgical decision-making.Methods The study’s descriptive, qualitative design involved holding interviews with breast surgeons and holding focus groups and interviews with women who were offered the choice of breast-conserving surgery (bcs) or mastectomy (mt).Results Participants included 35 women and 13 surgeons. High interest in mt and increasing requests for prophylactic contralateral mt were evident. A host of factors—clinical, demographic, psychosocial, education-related, and cultural—influenced the decisions. A key factor for women was fear of recurrence and a need to “just get rid of it,” but the experiences of others also influenced the decisions. Life stage and family considerations also factored prominently into women’s decisions.Conclusions Women with early-stage bca more often chose mt and often demanded prophylactic removal of the healthy breast. Findings highlight the importance of ensuring that women at average risk are appropriately counselled about the low likelihood of a subsequent contralateral bca and the lack of survival benefit associated with prophylactic contralateral mt. Findings also revealed other areas of presurgical discussion that might help women think through their personal circumstances and values so as to encourage informed surgical decisions.
Background: Mastectomy is often chosen by women for treatment of breast cancer, even when breast-conserving surgery (BCS) is an option. Newfoundland and Labrador has a high mastectomy rate. We documented the number of breast cancers over a given period in the province and their related surgical treatments, and explored the impact of several variables on surgical choice. Methods: A retrospective cohort design linked diagnosis data from the Newfoundland and Labrador tumour registry to surgery data from the Canadian Institute for Health Information Discharge Abstract Database. Data were extracted for all women aged 19 years or more in whom breast cancer was diagnosed in 2009-2014. Results: A total of 2346 cases of breast cancer with a linked surgical procedure were included. Most operations (1605 [68.4%]) were mastectomy procedures, with the remainder being BCS. Logistic regression analysis revealed that women were 1.82 times (95% confidence interval [CI] 1.64-2.02) more likely to have mastectomy for each unit of stage increase from 0 to IV and 1.15 times (95% CI 1.11-1.21) more likely for each unit of driving time increase. Conclusion: Tumour stage and driving time to a radiation facility significantly predicted Newfoundland and Labrador women's surgical treatment choices for breast cancer. Notably, mastectomy was the favoured choice across all age groups, tumour stages and geographical regions of the province. We hope that these results will galvanize efforts to better understand local surgical practices and assist in improving the quality of surgical care of women with breast cancer. Contexte : Les femmes atteintes d'un cancer du sein optent souvent pour la mastectomie, même lorsque la chirurgie mammaire conservatrice (CMC) est possible. Considérant que la province de Terre-Neuve-et-Labrador enregistre des taux de mastectomie élevés, nous y avons recensé durant une période donnée les cas de cancer du sein et les traitements chirurgicaux associés, et avons étudié l'influence de plusieurs variables sur le choix d'intervention. Méthodes : Suivant un modèle de cohorte rétrospective, nous avons apparié les données diagnostiques du registre des cancers de Terre-Neuve-et-Labrador aux données chirurgicales correspondantes de la Base de données sur les congés des patients de l'Institut canadien d'information sur la santé. Nous avons extrait les données de toutes les femmes de 19 ans et plus qui ont reçu un diagnostic de cancer du sein entre 2009 et 2014. Résultats : Nous avons retenu 2346 cas de cancer du sein avec prise en charge chirurgicale. La majorité des interventions (1605, ou 68,4 %) étaient des mastectomies; les autres étaient des CMC. Une analyse de régression logistique a révélé qu'avec chaque augmentation unitaire du stade (de 0 à 4), les femmes devenaient 1,82 fois plus susceptibles d'opter pour la mastectomie (intervalle de confiance [IC] de 95 % 1,64 à 2,02), et 1,15 fois plus susceptibles de le faire avec chaque augmentation unitaire du temps de conduite (IC de 95 % 1,11 à 1,21). Conclusion : Le stade de l...
BackgroundBreast cancer remains the second-leading cause of cancer death among Canadian women. Treatment for breast cancer often includes surgery. Many women have a choice between mastectomy (MT; removal of the entire breast) or breast conserving surgery (BCS; removal of the tumour and some noncancerous breast tissue) followed by radiation. However, Newfoundland and Labrador consistently has a higher rate of mastectomies than the rest of Canada. In this project, we aim to better understand that trend.Design and methods.A multi-method design was chosen. Surgical treatment data kept by the province will be examined to describe the number and types of breast cancer surgeries over time. Second, we will hold focus groups with women around the province who have made surgical treatment choices to explore influences on their decisions. Finally, semi-structured interviews with breast cancer surgeons and surgical residents will explore their opinions on surgical treatment choices.Expected impact for public health.Cancer treatment choices are complex decisions, affected by clinical, demographic and social variables. Understanding why women from Newfoundland and Labrador have the highest rate of mastectomy in Canada is critical to ensure they are receiving appropriate screening and care. Greater understanding of the influences on women’s surgical choices may encourage informed decisions amongst women and physicians and promote active communication about treatment, benefits relevant to all jurisdictions and health authorities. Further, if factors such as geographic proximity to treatment facilities are associated with treatment decisions, this information is important for public health screening and service planners.Significance for public healthCancer treatment choices are complex decisions, affected by numerous clinical, demographic and social variables. Research is needed to understand why women from Newfoundland and Labrador have the highest rate of mastectomy in Canada. Greater understanding of the influences on women’s surgical choices may help encourage informed decisions amongst women and physicians and promote active communication about treatment, benefits relevant to all jurisdictions and health authorities. Further, if factors such as geographic proximity to treatment facilities are associated with treatment decisions, this information is important for public healthcare spending and service planners. Finally, it is our hope the findings from this project could help improve the screening process and surgical care of breast cancer patients in Newfoundland and Labrador.
Background: Mastectomy (MT) rates are higher in Newfoundland and Labrador (NL) than in any other province in Canada, even in women diagnosed with early-stage breast cancer. In this article, we present qualitative data from women who made a surgical breast cancer treatment decision to better understand the decision-making environment and process. Methods: A descriptive, qualitative design was employed. Semi-structured interviews and focus groups were held with women in NL who underwent surgical treatment for breast cancer, including breast-conserving surgery (BCS) or mastectomy (MT). Results: Thirty-five women participated. 74.3% had MT, whereas only 11.4% had BCS. Additionally, 14.3% had BCS initially followed by MT. The surgical treatment decision-making context was heterogeneous. Women reported varying levels of time they had to make a surgical decision, diverse perceptions of decisional choice, opinions on the adequacy of information provided to inform a decision, and different levels of available formal and informal supports. Most reported they were satisfied with their surgical decision, although the context in which these decisions were made was clearly a challenging one. Conclusions: Although most women were pleased with the surgical care they received, adequate time and thorough pre-surgical discussion were noted as necessary but not always available. Women explained the importance of thinking through their personal circumstances and values so as to make informed surgical decisions. Postsurgical care and discussion of available psychosocial supports were proposed as areas that could be improved.
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